According to this study, the prevalence of HIV infection among 17–24 years old student MSM in Tian, China was 5%,which is higher than previous study from 2003 to 2016(5, 18, 19)but is consistent with report from UNAIDS about 16–24 years old YMSM in 2018(4).There was no statistically significance for the HIV prevalence between student MSM who had tested and who not(5.4%VS4.6%).A higher rate of recreational drug use(44.8%VS30.3%) among student MSM who had tested was found. This might be explained by the association between recreational drug use and high-risky sexual behaviors and STD infection(20–23). Risky behaviors and status may put students on HIV testing.
The purpose of this study was to examine the relationship between peer education and HIV testing among student MSM in China. Our study found that the rate of HIV testing was 60.5%, which is higher than a previous systematic review(53%)(18) about MSM attending university. Considering 83% of MSM attending university in this study, we did the above comparison. The higher rate in this study might indicate that HIV testing is gaining popularity among student MSM over time. However, this finding also presents a public health concern because 39.5% of student MSM are living with undiagnosed in the past year and even 33.2%never knew about their HIV-infection status, as a result, are unaware of their ability to transmit HIV.
In our study, we found that those who received peer education service were more likely to have tested for HIV, which is consistent with previous studies(15, 24, 25). School sex education in China is far from adequate, let alone education aiming at MSM(14). Chinese government and some non-government organizations are investigating effective ways to reach young men, and mobile phone apps have been applied(1). However, an online video intervention promoting HIV testing among never-tested MSM in China(26) demonstrated that students had a lower testing rate compared with nonstudents at follow-up probably because of fear of testing in local healthcare institutions. Given the circumstance, peer education may be a complementary intervention. Further study may be needed to assess the effect of peer education and other interventions to adjust prevention strategies based on local conditions.
Consistently with a study in Metropolitan Detroit in 2016(27),we found that YMSM ever tested for HIV were more likely to be older, seeking sexual partners on the Internet and having a STD history. In addition, we also found that relatively safe behaviors and status were more likely to be seen among YMSM who have tested such as condom use last time or consistently for last 6 months, having good perception of HIV-related knowledge, having heard about PrEP and PEP and having no anal sex last week. This may be an implication that risk-reduction behaviors are more likely to be seen among YMSM who had experienced HIV testing.
Our study has several limitations. First, although the students were recruited through different ways, the snowball sampling has its inherent disadvantages, as a result, are subject to selection bias. However, the sampling method is feasible for the concealment of the population. Second, the questionnaire was designed retrospectively and the answer was self-reported, so information biases were inevitable such as recall bias. For some sensitive questions, lying out of shame resulted in social expectation bias. The CBO conducted the interview in the private office with a professional researcher who was also MSM to guarantee authenticity largely. In addition, the cross-sectional design could not prove the causal relationship between peer education and HIV testing because we cannot determine the temporality.
Despite these limitations, few studies have assessed the relationship between peer education and HIV testing and factors associated with HIV testing among student MSM in China. Our study has important implications for HIV prevention among the hard-to-contact risky population in China.